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21-11-2019 | Rheumatology | News | Article

axSpA management needs to look beyond disease activity and function

medwireNews: To improve the quality of life (QoL) of patients with ankylosing spondylitis (axSpA), research suggests that fatigue, poor sleep, and mental health need to be addressed in addition to managing disease activity and function.

Gary Macfarlane (University of Aberdeen, UK) and study co-authors say that although the EULAR/ASAS guidelines for the management of axSpA do not mention mental health, sleep problems, or widespread pain, “[t]he results from this study suggest that their role is important, and independent of disease activity and functional limitation.”

The researchers used the 18-item Ankylosing Spondylitis Quality of Life (ASQoL) measure to assess 1810 axSpA patients recruited to the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) between 2012 and 2017.

They were able to validate four of five factors previously linked to poor QoL in 555 participants of the Scotland Registry for Ankylosing Spondylitis (SIRAS) study. These were BASDAI, BASFI, fatigue, and widespread pain. The regression coefficients of these factors ranged from 0.07 to 0.85.

On the other hand, spinal mobility (Bath Ankylosing Spondylitis Metrology Index [BASMI]) while associated with QoL in the SIRAS cohort, was not found to be so in the BSRBR-AS cohort, note the researchers in the Annals of the Rheumatic Diseases.

In addition to BASDAI and BASFI, depression, anxiety, and sleep disturbance were also significantly associated with poorer QoL in 1692 individuals in the BSRBR-AS cohort, with regression coefficients of 0.19, 0.12, and 0.10, respectively.

Activity impairment, fibromyalgia (Symptom Severity Scale), fibromyalgia (Widespread Pain Index), and current tobacco smoking status were also all significantly associated with QoL in 642 patients, with regression coefficients of 0.04, 0.24, 0.10, and 0.66, respectively.

“The current study confirms the important role of disease activity and function in terms of QoL but adds to the literature by emphasising the important independent role of additional features associated with axSpA: mental health, fatigue and sleep problems, and widespread pain,” say Macfarlane et al.

They highlight that “in addition to improving disease activity and function in patients, there must be attention to the comorbid features of fatigue, poor sleep and mental health and other common symptoms.”

But they acknowledge that there is currently little guidance on how to manage such comorbidities and the “expertise and resources to deliver the interventions to target these additional factors are not easily available to many rheumatology teams.”

By Hannah Kitt

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Ann Rheum Dis 2019; doi:10.1136/annrheumdis-2019-216143

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